intra-operative imprint cytology of sentinel lymph node: how many second operations are avoided?

630 ABSTRACTS

Introduction: Perioperative Endocrine Therapy - Individualising Care

(POETIC) is a currently on-going national randomised trial that is looking at

the effect of endocrine therapy 2weeks before and2weeks after surgery in hor-

mone-sensitive breast cancer.We reviewedpatients recruited for the trial to see

whether short-term therapy with letrozole influenced surgical outcomes.

Methods: Seventy patients enrolled on POETIC were identified from a

prospectively entered trial database. The main outcome measures studied

were sentinel lymph node (SLN) detection rates, cancer reoperation rates,

hospital stay, complications and unplanned readmission following surgery.

Results: See Table 1.

Table 1

Control Group

(n¼24)

Endocrine Therapy Group

(Letrozole 2.5 mg once daily) (n¼46)

Median age (range) 68 (55-83) 65 (52-83)

Percentage having mastectomy: WLE: Localisation WLE 25%: 50%: 25% 28%: 44%: 28%

Percentage requiring axillary clearance 33% 30%

SLN Identification rate 95% (19/20) 100% (46/46)

Percentage of patients receiving 1, 2 or 3 operations for cancer 71%:21%:8%

(17:5:2)

78%:20%:2% (36:9:1)

Percentage of patients returned to theatre for complications 4% (1) 4% (2)

Percentage of patients requiring re-admission for complications 8% (2) 2% (1)

Median inpatient nights per patient (range) 1 (0-10) 1 (0-6)

Conclusions: Pre-and post-operative short term letrozole therapy does

not seem to have an impact on early surgical outcomes.

http://dx.doi.org/10.1016/j.ejso.2014.02.069

Imprint cytology Returned to theatre

Excision of

margins/mastectomy

Axillary

clearance

Negative (n¼253) 31 11

Positive (n¼46) 8 0

Indeterminate (n¼8) 6 2

Total (n¼307) 45 13

P070. Patients treated with oncoplastic breast conservation require

more postoperative radiological imaging, consequent biopsy and

outpatient clinic visit than patients who had simple wide local

excision e A controlled study

Meera Patel1, Ross Dolan1, James Mansell2, Sheila Stallard2,

Eva Weiler-Mithoff3, Julie Doughty2, Laszlo Romics1

1 Victoria Infirmary Glasgow, Glasgow, UK2Western Infirmary Glasgow, Glasgow, UK3Royal Infirmary Glasgow, Glasgow, UK

Background: Oncoplastic breast conservation surgery (OBCS) is a

more complex, technically demanding surgical technique than simple

wide local excision (WLE). Further, after OBCS it is more challenging

to interpret postoperative surveillance imaging. Hence we compared num-

ber of postoperative imagings, biopsies and outpatient visits in patients

treated with OBCS and simple WLE.

Methods: Consecutive patients treated with level II OBCS (n¼84)

were compared to patients who underwent simple WLE (n¼319) in

the same unit during similar period of time. Number of imagings, bi-

opsies and outpatient visits were compared using student’s t-test

within the initial 24 months postoperative period. Difference

was considered statistically significant when p value was less than

0.05.

Results: OBCS patients required significantly more postoperative ul-

trasound (OBCS:0.595[0-6] per patient vs. WLE:0.091[0-3];p<0.0001),

MRI (OBCS:0.095[0-3] per patient vs. WLE:0.015[0-1];p¼0.004), and

breast biopsy (OBCS:0.44[0-3] per patient vs. WLE:0.019 [0-

1];p<0.0001). Abnormal findings on postoperative imaging were also

much more frequent after OBCS (0.143[0-2] per patient vs.

WLE:0.012[0-1];p<0.0001). This required more clinic visits from pa-

tients who were treated with OBCS (4.583[0-13] per patient vs.

WLE:1.99[0-7];p<0001). The total number of postoperative imaging

was also higher after OBCS (mean 2.25[0-8] vs. WLE:2.01[7-

1];p¼0.0842).

Conclusion: More frequent postoperative breast ultrasound, MRI, and

more common abnormal radiological findings, and consequent breast bi-

opsies reflect the relative complexity as well as novelty of OBCS.

Informed consent for OBCS should include the above facts and patients

should be discussed that they are more likely to come often to the outpa-

tient clinic and have radiological tests and biopsies after OBCS compared

to simple WLE.


P071. Intra-operative imprint cytology of sentinel lymph node: How

many second operations are avoided?

Naomi S. Sakai, Katie Herman, Deepak Shrestha, Michael Pittam,

Maria Nayagam, Duraisamy Ravichandran

Luton and Dunstable University Hospital, Luton, UK

Introduction: Intra-operative testing of sentinel lymph node (SLN) is

performed so that in patients with a positive SLN, axillary surgery can be

completed in one sitting. However, a second operation may then become

necessary to clear margins of the primary tumour. Our aim is to study

how many second operations are avoided by intra-operative imprint

cytology (IOIC).

Methods: We identified all patients who underwent IOIC over a 4-

year period at our institution from a prospectively entered database

and reviewed their details to see how many second operations were

avoided.

Results: 307 patients were identified. Most had preoperative ultra-

sound +/- FNAC of axilla which was negative. IOIC was negative in

253, indeterminate in 8 and positive in 46 patients. All positive patients

had axillary clearance in the same sitting but 8 patients needed further sur-

gery later for close margins. 13 patients required a delayed axillary clear-

ance for false negative/indeterminate imprint with positive SLN on

histology.

Conclusions: Intra-operative testing on 307 patients prevented 38 re-

operations. A delayed axillary clearance was only required in 13 out of

307 patients. Recall for further surgery can be distressing to patients and

axillary clearance after previous SLNB can be technically challenging.



ABSTRACTS 631

Imprint cytology is neither costly nor time consuming thus we feel it is a

worthwhile addition to breast cancer surgery even when the axilla is

deemed negative on pre-operative ultrasound.


P072. Patient-reported outcomes of breast reconstruction using

implant and biomesh: Our experience

Anuradha Apte, Angela Haigh, Sankaran Chandrasekharan, Arunmoy

Chakravorty

Colchester Hospital University NHS Foundation Trust, Colchester, Essex,

UK

Introduction: Breast aesthetics and patient awareness have made

breast reconstruction an integral part of breast cancer surgery alongside

mastectomy and breast conservation. Our objective was to evaluate pa-

tient-reported outcomes after immediate breast reconstruction (IBR) using

implant and biomesh (Strattice).

Methods: In this prospective ongoing study, consecutive patients who

had an IBR using implant and Strattice from February 2012 received a

questionnaire 6 weeks post-surgery. Questionnaire included pre-operative,

operative and post-operative outcomes including patient satisfaction,

cosmesis, return to activity and complications.

Results: Between February 2012 and October 2013, 19 patients (2

bilateral, 14 Left, 7 Right) underwent single-stage immediate breast recon-

struction with fixed volume profile implants and Strattice. Options of

different reconstructive procedures were discussed along with specialist-

nurse consultation. Unavailability of long-term data of using biomesh

was clearly stated. One patient didn’t reply. There were 5 ILC, 9 IDC, 2

Mixed, 5 DCIS with 16 ER-and 2 HER-2 positive cancers. NPI range

was 2.2-5.8. Adjuvant-treatment included radiotherapy (3), chemotherapy

(3), Herceptin (2).

Average hospital stay was 1.59 days (range 1-3 days). Return to light

and normal activities was 2.24 and 5.57 weeks respectively.72% patients

were comfortable with and 66.66% without bra. No lifestyle changes in

15. Complications included implant loss in two (one after 3 months), hae-

matoma (1), seroma (3), distant metastasis (2). Eighteen would recom-

mend reconstruction and 83% patients were very satisfied.

Conclusion: IBR using implant and biomesh is a good option in

selected cases, considering less operating time, early recovery, return to

normal activities and well-balanced patient reported outcomes.


P073. Novel classification to facilitate recognition of breast cancer

morphology on confocal endomicroscopy

Tou Pin Chang1, Sami Shousha3, Dimitri J. Hadjiminas4, Rathi

Ramakrishnan3, Ragheed Al-Mufti4, Kumuthan Sriskandarajah1,

Guang Zhong Yang2, Ara Darzi1, Daniel R. Leff1

1 Department of Surgery and Cancer, St Mary’s Hospital, Imperial College

London, London, UK2The Hamlyn Centre, Institute of Global Health Innovation, Imperial

College London, London, UK3Department of Histopathology, Charing Cross Hospital, London, UK4 Imperial Breast Unit, Charing Cross Hospital, London, UK

Introduction: National data suggests that a significant proportion of

breast cancer patients require re-excision. Novel intra-operative visualisa-

tion tools may aid real-time assessment of cavity margin status. Our work

demonstrated that breast cancer morphology could be visualised in real-

time using confocal endomicroscopy (CE). This study assesses the ability

of pathologists and surgeons to differentiate CE images of neoplastic from

non-neoplastic breast morphology using a novel classification.

Methods: CE images obtained from 71 freshly excised, acriflavine-

stained breast tumour and non-diseased sections from 50 patients were

reviewed with two experienced breast pathologists. A classification based

on description of CE morphology unique to normal breast tissue constitu-

ents, non-invasive and invasive disease was developed. Seventeen pathol-

ogists and surgeons underwent a pattern recognition training session

based on this classification and subsequently, were subjected to objective

assessment of 50 CE images while blinded to histopathology results.

Results: The mean sensitivity, specificity and accuracy for the detec-

tion of breast cancer for pathologists was 96% (range 88-100%), 92%

(range 84-100%) and 94% (range 90-100%), respectively. Surgeons had

a mean sensitivity of 97% (range 92-100%), specificity of 86% (range

68-96%) and accuracy of 92% (range 84-98%). Overall inter-observer

agreement for pathologists was ‘almost perfect’, k¼0.82 (95%CI, 0.79-

0.85); and ‘substantial’ for surgeons, k¼0.74 (95%CI, 0.70-0.78).

Conclusions: CE morphological features of breast cancer are objec-

tively distinguishable from that of normal breast. There might be a poten-

tial role for the use of CE intraoperatively as an adjunct to current

techniques for in situ detection of residual cancerous foci based on real-

time cavity scanning.


P074. Breast cancer detection rates in patients with B3 breast lesions:

A 10 year retrospective review

Nadia Mcallister, Preet Hamilton, Stewart Nicholson, Nerys Forester

The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle

upon Tyne, UK

Introduction: B3 lesions comprise a heterogeneous group of breast le-

sions with an increased risk of subsequent breast malignancy.1 Surgical

excision of such lesions is being replaced by large volume core needle bi-

opsy and 5 yearly mammographic follow up.2 This study aims to establish

the incidence, nature and timing of malignancy associated with B3 lesions,

and to assess whether such mammographic surveillance programmes are

appropriately targeted.

Methods: Retrospective, single large centre, review of all screen de-

tected B3 lesions (identified on core or diagnostic excision biopsy) be-

tween 1995 and 2006.

Results: 131 B3 lesions were identified. Average age was 55 years

(range 48-74). Each patient had a median of 4 follow-up mammograms

(range 0-9). 8 cases (6%) subsequently developed breast cancer (7 inva-

sive, 1 high grade DCIS). Median time-to-diagnosis was 5 years (range

1-15yrs). 3 patients were diagnosed after 1 year (all at the original site).

6/8 cancers were in the ipsilateral breast, but only 4/8 were at the same

site as the index lesion.

Conclusions: The observed cancer detection rate of 6% is higher

than expected for a screened population. However, in this cohort, subse-

quent cancer occurred either early, representing a failure of initial

assessment, or much later, consistent with studies suggesting that the

presence of B3 lesions are a risk factor for breast cancer development.1

We propose a more appropriate and cost effective follow-up strategy of a

single mammographic review at one year followed by return to the

routine NHS breast screening programme, in conjunction with regular

self examination.

References

1. Heywang-K€obrunner SH, N€ahrig J, Hacker A, Sedlacek S, H€ofler H. B3Lesions: Radiological Assessment and Multi-Disciplinary Aspects.

Breast Care (Basel) 2010: Aug;5(4):209-217.

2. S. Rajan, A.M. Shaaban, B.J.G. Dall, N. Sharma. New patient pathway

using vacuum-assisted biopsy reduces diagnostic surgery for B3 le-

sions. Clin Radiol 2012: Mar;67(3):244-9.






intra-operative imprint cytology of sentinel lymph node: how many second operations are avoided?

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